Narrative Theory in Clinical Social Work Practice

By John P. McTighe

This theory-to-practice guide offers mental health practitioners a powerful narrative-based approach to working with clients in clinical practice. It opens with a primer on contemporary narrative theory and offers a robust framework based on the art and techniques of listening for deeper, more meaningful understanding and intervention.
Chapters expand on these foundational concepts by applying them to a diverse range of populations and issues, among them race and ethnicity, human sexuality, immigration, and the experience of trauma, grief, and loss. The author’s engaging voice, thoughtful pedagogical style, and extensive use of examples and exercises also work together to inform the reader’s own narrative of growth and self-knowledge.
Included in the coverage:• Encountering the self, encountering the other: narratives of race and ethnicity.• Surviving together: individual and communal narratives in the wake of tragedy.• Spiritual stories: exploring ultimate meaning in social work practice.• Sexual stories: narratives of sexual identity, gender, and sexual development.• Leaving home, finding home: narrative practice with immigrant populations.• Moving on: narrative perspectives on grief and loss.
Narrative Theory in Clinical Social Work Practice is geared toward students as well as seasoned social workers, and professionals and practitioners in related clinical fields interested in informing their work with a narrative approach.

• Language: English
• Publisher: Springer
• Release date: Jan 3, 2018
• ISBN: 9783319707877

Book preview

© Springer International Publishing AG 2018

John P. McTigheNarrative Theory in Clinical Social Work PracticeEssential Clinical Social Work Serieshttps://doi.org/10.1007/978-3-319-70787-7_1

1. Narrative Theory: An Introduction and Overview

John P. McTighe¹ 

(1)

School of Social Science and Human Services, Ramapo College, Mahwah, NJ, USA

Keywords

NarrativeNarrative turnPostmodernismSocial constructionismThe storied nature of experienceMeaning-making

Guiding Questions

What do we mean by narrative and what are its implications for the practice of clinical social work?

What are the philosophical underpinnings of narrative theory and what do they have to tell us about the human person and our quest for identity and meaning?

What is the relationship between the narratives we construct and what we generally think of as truth?

What are the key dimensions of our presence with clients as social workers working from a narrative perspective?

How are we to understand the reflexive relationship between narrative and culture?

Some time ago, as I was walking across campus with a colleague, she ran into a young man who had graduated from our program the year before I joined the faculty. She was clearly happy to see him, and I quickly understood that he had been an excellent student. As she introduced us she told the young man, This is Dr. McTighe. You should really talk to him. He studies narrative. Really? the young man asked. Yes, I replied. Are you interested in narrative? He pondered that for a moment and said, It depends. What do you mean by narrative? My eyes widened a bit and I told him, Well, that’s exactly the right question to ask! Whether he knew it or not, that young student was articulating a question that scholars have been pondering and debating for decades: What is narrative?

This is a book about narrative and its role in the theory and practice of clinical social work. Through each chapter we will consider the contribution of the narrative perspective to a variety of contexts and with a variety of client populations. As we take this journey, it is my hope that we will come to a clearer understanding of narrative and the ways in which it can enhance our thinking and our practice. But in order to have some solid ground on which to stand, it is important that we lay a foundation—a clear sense of what we mean when we talk about narrative.

The first time I went to a conference on narrative to present a paper I had been working on, I felt like a fish out of water. I was the only social worker there, at least as far as I could tell. To my surprise honestly, I was surrounded instead by literature professors, philosophers, anthropologists, and historians. At times, it felt as though we were speaking different languages. We thought of narrative in seemingly different terms, cited different theorists, and saw different implications to our work. What that conference taught me, among other things, was just how diverse the world of narrative is. And, as is often the case, listening to and reflecting on multiple points of view did a great deal to clarify and even enhance my own thinking.

Like all stories based on living human experience, the story of narrative is an ever-evolving one. And like all stories of human experience, the perspective or interpretation you get will depend on the person you ask. Literary theorists, anthropologists, historians, philosophers, psychologists, and social workers understand and apply the narrative perspective each through their own lens and from their own vantage point. As interest in narrative has proliferated over the past 30–40 years, some have even posed the question of whether narrative has come to mean anything and everything (Riessman & Quinney, 2005, p. 393). That said, while our understanding of narrative may be very broad, we will nonetheless attempt to sketch an outline of what narrative is. In this chapter, we consider an overview of narrative theory and some of its philosophical underpinnings. Flowing from this, we will look at the way narrative has had an impact on the humanities and the social sciences broadly speaking. We then take a look at the meaning and applications of narrative for the practice of social work in a general sense.

The Conceptual History of Narrative

Though a full exploration of the conceptual history of narrative is beyond the scope of this chapter, it is nonetheless important for us to take a tour through it to understand the state of the debate and have a clearer sense of the perspective that social work can bring to bear on the theory of narrative and its implications for clinical practice.

In the 1960s, a shift began to occur, first in the field of literary criticism, then history, and later (more into the 1980s) in the social sciences. This shift has been called the narrative turn , or inasmuch as it has presented itself differently in diverse fields of inquiry, narrative turns (Hyvarinen, 2010). At its root, the narrative turn emerged from movements within the philosophical landscape that began to reconsider the nature of knowledge and what we consensually refer to as reality . What are we able to know? How? And with what degree of certainty?

Narrative falls under the broad umbrella of a school of thought known as postmodernism. Its philosophical predecessors, modernism or some might say positivism , were deeply invested in the human capacity to achieve knowledge and understanding through reason. Modernism espoused a view of reality , nature, etc. as inherently and objectively knowable in and of itself, particularly through the application of human reason. By contrast, postmodernism takes a skeptical view of this stance and suggests that while the world is of course real, our access to it through knowledge and understanding is contingent, hampered by the limitations of time and the culture-bound men and women who observe and comment on reality.

Consider for example that, centuries ago, reasonable people held with great certainty that the world is flat and pointed to all the reliable scientific evidence that this was the case. As an epistemological stance, postmodern thinking suggests that our ability to know is impacted by the inherent biases that each of us brings to the task of observation, thought, and reflection as knowers . In other words, what I know is conditioned on who I am as a knower. If you have had the opportunity to travel to a different part of the world, or even to spend some time immersed in a culture that is very different from your own, you likely already have an intuitive sense of what this is all about. Two human beings observing a phenomenon from radically different points of view may in fact see quite different things and have very distinct thoughts and feelings about it. What is more, they may have entirely different systems of language that they use to express those points of view and the meaning they make out of what they experience (Freedman & Combs, 1996).

Under this broad umbrella of postmodern thought, we must consider a related perspective: social constructionism . As one dimension of the postmodern point of view, social constructionism takes the view that not only is the knowability of the world and our actual knowledge of it limited by our own perspective, but also this perspective is constructed by the social and cultural environment in which we develop (Gergen, 2015). None of us exists in a vacuum. Social constructionism holds that we are each shaped by the perhaps countless subtle dimensions of the social world in which we live, and that we individually and collectively take part in the ongoing creation of that world and the meaning we make of it. In other words, our environment shapes us and we in turn shape our environment. This has enormous implications for, and gives rise to, the narrative perspective that is the heart of our consideration here. It is also worth noting that this understanding is particularly important to a narrative approach to clinical social work given the biopsychosociospiritual perspective that fundamentally undergirds our work. Emerging from this social constructionist perspective , narrative theory in its simplest iteration looks at the way human beings recount their experience of being human and give meaning to that experience. For our purposes as clinical social workers, this has significant implications for our understanding of people and practice.

As a critique of culture and the many ways of knowing, postmodernism and social constructionism alert us to the ways in which cultures and societies, as well as the many subgroups of which they are composed, commonly seek to reify their perspective or their knowledge as if it is inherently true and immutable for all people at all times and in all places—as if it exists out there in a purely discoverable way (Neimeyer, 1993). In short, they believe they have a lock on truth . This phenomenon is played out on every level from the individual to the family, group, organization, and community. We see it displayed in media, popular culture, music, and political campaigns and international relations. It comes to us in the form of extended debates and arguments, as well as slogans, bumper stickers, and social media messages. If we listen carefully, we are surrounded by messages seeking to convince us of the truth, of the way things really are.

Berger and Luckmann (1966) in their seminal writing on social construction suggest that this process of reification has several components, namely typification , institutionalization , and legitimation . That is, we human beings organize our observations about the world into categories or types. We do this as a way of making sense of the world. We create these types along religious, ethnic, racial, or other demographic lines. We create categories of health and mental health conditions into which we classify people. We divide others and ourselves according to types of interests , activities, political beliefs, geographical locations, and on and on. Berger and Luckmann (1966) note that we then over time institutionalize those types and structure our social functioning around them. In other words, we take the types or categories we have constructed and grant them a privileged role in our discourse. This in turn leads to the legitimation of these institutions as having some sort of power or reality on their own. Over time (whether years, centuries, or even millennia), we lose the awareness of how these types and institutions are themselves products of our own socially constructed narratives.

Think for example of recent cultural debates around marriage. When you read that word—marriage—tune in to your associations to it. What do you think, feel, and imagine? Ask yourself what your sense is of the place or role of marriage in society. Consider the intense and often heated discourse that has unfolded in the United States and in other countries as well about the definition of marriage and who should have access to it legally, religiously, and otherwise. Marriage is an institution in cultures around the world. But this social and cultural institution is also a type in Berger and Luckmann’s (1966) language, and our understanding(s) of marriage are socially constructed. The meaning and role of marriage and the way it is lived out vary in different social and cultural contexts. In these contexts, marriage as a type is institutionalized and thereby legitimized. In other words, marriage is what we say it is because that is the tradition that has been handed down to us, and that is what we believe. Hence, altering this kind of social construction is commonly a slow-moving, complex process.

By way of summing up, Freedman and Combs (1996) have suggested that this social constructionist perspective leads to four key ideas: (1) Realities are socially constructed. (2) Realities are constructed through language. (3) Realities are organized and maintained through narrative. (4) There are no essential truths (p. 22). That last assertion may be particularly striking to you. Are we really saying that there is nothing that is really true (Spence, 1982)? Nothing that is knowable? Not exactly.

The balance, I would suggest, comes in the humility with which we pursue understanding of any dimension of life and experience, and the lightness with which we hold onto our sense of truth—particularly when it comes to the way in which human beings make meaning out of their experience. For example, we might take a rather smug and dismissive view of our scientific ancestors who somehow convinced themselves that the world is flat. We might remind ourselves how much more we know and how much more we have observed about the universe, and in so doing tell ourselves that we now know the way things are. But the truth, if you will, is that we now know only what we now know. We need to be aware that, for all of our advances, we have no idea what yet remains to be discovered, or how our knowledge and understanding will evolve over centuries to come. Similarly, members of societies that think of themselves as relatively advanced might be tempted to adopt an attitude of superiority over other cultures they consider to be less developed.

One of the gifts that we have been given by the discipline of anthropology is to be able to experience and hopefully understand diverse cultures on their own terms, and to consider life and the world from their perspective. While we remain nonetheless free to disagree and to maintain our own system of beliefs, this kind of cross-cultural understanding can do a great deal to foster empathy, cooperation, and even social justice. From a social work point of view, that is of course exceedingly valuable.

On a more directly interpersonal level, when we come face to face with another human person , we cannot pretend that we know all there is to know about them, or that any one single theory tells us everything there is to be known. Even as we consider our own subjective life experience, we must humbly realize that our sense of our very selves is limited by time, history, culture, gender, socioeconomic status, sexual orientation, and more—and the deeply powerful mutual interaction of all of these. Furthermore, when we, as social workers, open ourselves to the life experience of another human being , we automatically bring the biases and limitations that are part and parcel of our own limited experience of life and the world. I suggest that we need not think of this as a flaw to be overcome, however, as much as an inevitable dimension of personhood and one of which we must be continually aware. In order to practice effectively, it is of great benefit if we are deeply curious about the mystery of the person before us.

Consider this example. When I work with students in social work practice class or in clinical supervision to learn the skills of active listening and empathy, students readily acknowledge that they must suspend judgment and avoid telling clients what to do. That’s pretty clear, even when we’re beginners. Yet, time and time again I’ve gotten them to engage in role-playing around these skills and then listened to how frustrated they became. I told myself I wasn’t going to give advice. I wasn’t going to judge. I was just really going to listen. And yet there I was five minutes in, telling the client what to do! That in and of itself, I suggest, is an important lesson. It is challenging to be in touch enough with our own story and perspective to suspend it, hold it in awareness as if off to the side, and really listen to the story of another. It is challenging to trust that if I am patient and attentive I will understand more as I listen more. This is not to say that we will never respond or intervene. But as I hope you will discover throughout this book, narrative theory and practice suggest that my interventions will be deeper and more helpful if I listen attentively to the story of the client.

For this reason, one of the things that I hope comes through most clearly and powerfully throughout this book is the delicacy that is required of us as clinical social workers as we sit with, listen to, and interact with the complexity of the human stories that we are privileged to hear in our work. Each encounter we have with a client is a meeting of worlds—those of the client and the social worker. As a social worker, you are the instrument of your work. If you have been in practice for some time you know this to be true. At times you will work with clients who might appear quite different from you. At other times, they will seem quite similar. They may be people we wish to befriend, or people we don’t honestly like. We may struggle to understand them or feel an instantaneous connection.

With each and every client, the discipline of our profession calls us to be self-aware and to notice what is evoked in us as we attend to the client. To help us in this regard, we may rely on both the classic and the developing scholarly literature on countertransference and the role it plays in the therapeutic relationship (Counselman, 2014; Lia, 2017; Oelsner, 2013; Viderman, 2010; Wolstein, 1988). We pay attention to the ways that our own story, particularly our own biases, may be evoked, and we do our utmost to contain them so that they interfere less with our ability to be open to the unfolding story of the person in front of us. We also seek to develop our awareness of what the very act of coming together with another person for help means in our cultural narratives. All of this remains true whether we work with individuals, families, groups, communities, or organizations.

Let’s consider another example. A social worker at a local mental health clinic is scheduled to conduct an intake with a 52-year-old woman named Jessica who states that she would like to talk about some struggles she has been having. When they meet, the client tells the social worker that she has been feeling depressed for some time. For more than a month, she has been feeling pervasively sad, helpless, and hopeless. She has little energy and, though she has continued to function in a basic way, feels that she has been lacking motivation. The client notes that while she has been feeling quite bad over these past weeks, she has struggled with depression throughout most of her adult life. Most of the time she is able to keep the sadness at bay, but sometimes it feels overwhelming—like now.

As the social worker listens more deeply, she hears the client talk about her view of life and the world. Life is all about struggle, she thinks. No matter what you do you can never really get ahead. No matter how hard you try, it will all end up being pointless. The client notes that though she has some casual friendships, there is no one really close to her. She was married for 6 years in her 30s, but that ended in a contentious divorce. She has two children who are mostly wrapped up in their own lives. Fundamentally, she believes that the reason things never work out for her is that she does not deserve happiness. There must be something wrong with her as a person since she has had more than her fair share of hardship.

At this point, I’d like to invite you to pause and tune in to what you are thinking and feeling about this client. What else do you imagine about her? Do you have a mental picture of her? Some fantasy about the underlying causes of her painful depression ? What else do you need to know about her, her history, and her social world to have a fuller understanding of what she is going through? And what difference would that information make?

For example, imagine how you might respond to her story if she had been raised in foster care on the one hand, or in a comfortable home with a large family on the other. Imagine if she were socioeconomically disadvantaged or financially well off. Imagine if she were Caucasian, or African-American, or Latina, or Asian. What if she identified as heterosexual, or lesbian, or transgender? What if she had experienced trauma or oppression and discrimination?

All human experience emerges from a multifaceted context that takes into account not only the characteristics with which we are born into the world, but also the ways in which the social environment conditions and shapes our development. And in order to make meaning of all that experience, human beings continually tell stories—stories of our self, the world, and our self in the world. This is a phrase that I often use and that I find to be helpful in understanding narrative in sociocultural context. It captures for me the dynamic interplay between the individual and the environment in a way that is deeply important if we are to tap into the multilayered construction and meaning of our clients’ stories.

A number of theorists have discussed this human disposition to tell stories as a means of understanding experience and relating it to others. Sarbin (1986), for example, refers to the storied nature of human conduct . That is, while our direct experience of the world may not, in and of itself, unfold as a story, any attempt we make to relate that experience to others or even reflect on it compels us to frame that experience along the lines of a story. We give it a beginning, a middle, and an ending, even if only an imagined one. This structure undergirds our efforts to make meaning of the mass of perceptions that first constitutes and that we continually integrate into our story of self, life, and the world (Polkinghorne, 1988).

Crossley (2000, 2003) has also elaborated upon the way in which we make meaning out of events by organizing them into an ordered sequence. This, she suggests, occurs along two lines. The first is temporal—the laying out of events chronologically. The second is relational. We look for the connections between events and try to understand the ways in which different pieces of our experience relate to each other and fit into the overall schema of our life. Crossley (2003) notes that language, in both its psychological and sociological dimensions, is the key building block of this effort. For this reason, one of the elements that lie at the core of a narrative approach to practice is a keen attention to the language clients use as they relate their story as well as the way in which the movement of the story unfolds. Saari (1991) comments,

A story contains a structure and an order of meaning that the events of the real world do not possess even if they are considered in temporal sequence. A pure chronology lists in order of sequence every event that may have occurred in a particular arena regardless of its importance or relevance to anything. In contrast, a story selects temporally ordered events according to their causal relevance for a particular end point. (p. 139)

In keeping with the social constructionist foundations of narrative it is essential to remember that human stories always unfold in the context of the social and cultural worlds in which we live (Neimeyer, 2005). None of us recounts our experience in a vacuum. When we think of and connect emotionally to our story, and when we relate that story to the world, we do so in ways that we hope will be received, understood, and embraced by the world around us. When this does not happen we may feel isolated and misunderstood. Most, if not all, of us have had some experience with feeling misunderstood in this way. However, there are many for whom the pain that results when their narrative is not endorsed by the culture is an enormous burden reflected in the experience of marginalization and oppression.

If I suffer from what we more or less consensually refer to in the industrialized world as a mental illness , I may have any one of a number of ways of understanding what that means (McTighe, 2015). I may think of it as a biological illness. I may think I am crazy. I may view myself as under a curse or spell of some sort. I may also think that I have been misunderstood and labeled in a way that marginalizes and oppresses me. I may believe any of these things because others around me or in the world at large have communicated them to me. These varied interpretations will have a great deal to do with social and cultural factors like age, education, socioeconomic status, race and ethnicity, gender, and sexual orientation . They are also open to reconfiguration over time and with exposure to new information. This is one of the reasons we believe that a key intervention in the treatment of mental illness is psychoeducation.

It must be noted, however, that this capacity for an evolution of understanding (or narrative) applies not only to individuals and families, but also to culture itself. Even in the Western world, think of how our understanding of mental health and illness has evolved over centuries. So too has our response to it. We have moved from a time of possession and exorcisms to exile and institutionalization in asylums, to assertive community treatment. Even our language has evolved. Consider that pejorative words like lunatic were once used as clinical terms when our best understanding suggested that mental illness was somehow connected to the phases of the moon. Similarly, I have noted elsewhere (McTighe, 2015) that the antiquated diagnostic label of hysteria comes from the Greek word for uterus—huster. This was rooted in the cultural understanding of the nineteenth century that the etiology of the symptoms of hysteria was connected to female anatomy and hormonal cycles. On a social and cultural level, it came to serve as a means (intended or unintended) of marginalizing and minimizing women and their emotional experience.

Jerome Bruner (1986, 1987, 1990, 1991) is among the scholars who have made the greatest contribution to our understanding of this relationship between narrative and culture. He comments that there is a reflexive relationship between narrative and culture such that culture shapes our narratives, and narratives in turn shape the culture (Bruner, 1991). In other words, the narrative that each of us constructs as individuals is shaped by the social and cultural context in which we live. We then as individuals have a hand, however small, in shaping the culture that surrounds us.

If you want to know this is true, think about conversation among adolescents . This is a key place where language evolves and new expressions are born. These expressions are not only tied to age, however. They depend on racial, ethnic, and socioeconomic factors as well. They vary from inner cities to suburbs, and even regionally around the country and world. If you are not part of that cultural context, the interaction between young people may actually be quite hard to understand. Commonly though, these forms of expression start making their way through the broader culture around them. This is partly because adolescents bring their speech with them as they age, but also because they have an impact on families, groups, and the wider society . As these new forms of speech make their way through the culture, they often actually lose their appeal to the group from which they sprang.

When I try to make this point to my students in class, I will sometimes start talking without explanation in some form of really outdated slang. Since there is usually a great deal of diversity among my students I may use expressions that are not common in my culture of origin. Almost inevitably the students will start to laugh. I tell them to pause and ask themselves why they’re laughing. They will start off by saying things like No one says that anymore! They will usually then comment that they didn’t expect someone like me (i.e., of my age, race, ethnicity, education, and so forth …) to talk that way. What they tune into pretty quickly is an insight that is so deeply ingrained in us that we don’t even think about it—language and narrative belong to culture—culture that shapes us and that we in turn shape by the way we live and embody it. When they perceive me as outside the culture reflected by that speech act, they do not expect me to express myself in that way.

Bruner (1991) takes his comments on this phenomenon even further by noting that culture itself provides us with a shared set of meanings—like a narrative menu. On the one hand, this offers us a range of options for narrative self-expression. On the other hand, it limits in some sense our choices, not only for how we relate or communicate our experience, but also of how we understand that experience in the first place. Of course a culture is made up of any number of subcultures and can allow for a multiplicity of possible meanings. All one needs to do is watch a political debate during an election year to witness the way in which groups of people from a broadly similar culture espouse divergent interpretations of the same events. If we consider this on a more granular level, we may note that not only different political parties have different narratives of the political scene, but so too do different regions, socioeconomic groups, genders, ethnic and racial groups, etc. We saw this dynamic at work clearly in the 2016 US Presidential election. Political polling can become extraordinarily complex as each campaign tries to understand how their narrative or message is playing with all of the cultural subgroups.

Anthropologists work at decoding and cataloging the ways in which diverse cultures make sense of experience . They may spend years listening and observing in order to capture the nuance of words, gestures, rituals, and other forms of cultural expression. I suggest that a good deal of the fascination in this is the seemingly infinite number of way human beings have of making sense of and constructing their worlds. And from this, whether in a faraway land or much closer to home, the narratives of human life and experience flow.

In line with this thinking, Howard (1991) has suggested that culture is itself the consensus developed in community about how to make meaning of experience. The implications of this for the practice of social work are significant. Saleeby (1994) notes that in our work we stand at the intersection of the meaning-making systems of the client, the worker, and the culture at large. This is true whether we work with individuals, families, groups, organizations, or communities. On each of these levels, he suggests, part of our responsibility as social workers is to tune into the ways narratives may emerge from and even support oppressive structures in the social environment, and to challenge these for the betterment of our clients. From a narrative research perspective, Josselson (1995) notes that narratives are records of the meaning-making systems of human persons and that attending to narrative is a means to understanding how people make sense of the world.

When discussing the social constructionist foundations of narrative earlier, I acknowledged that these might raise in the minds of some the question of whether there is anything knowable or true. This applies not only to the overarching scheme of life and the world as a whole, but also to the individual person who is struggling to make sense of their experience and understand their own identity in context. Bruner (1987) offers a powerful insight about this.

The heart of my argument is this: eventually the culturally shaped cognitive and linguistic processes that guide the self-telling of life narratives achieve the power to structure perceptual experience, to organize memory, to segment and purpose-build the very events of life. In the end, we become the autobiographical narratives by which we tell about our lives. (p. 15)

This is the dynamic we see in clients, families, and even communities when